Open Wounds

Table of Contents

Definition

A wound is an injury that causes either an internal or external break in body tissue. An open wound (as in a knife cut) is a break in the skin or mucous membrane.

Description

The most common accidents resulting in open wounds are falls, mishandling of sharp objects, accidents with tools or machinery, and car accidents.

A closed wound (a contusion or internal bleeding) is a bruise that damages the underlying tissue without breaking the skin (as in a black eye).

There are at least five different types of open wounds:

Abrasions

An abrasion is a skin wound caused by rubbing or scraping the skin against a hard, rough surface. Bleeding in this type of wound is usually limited, but it is important that the skin be cleaned in order to guard against infection.

Incisions

An incision is a cut caused by a knife, the rough edge of metal, broken glass, a razor blade or some other sharp object. This type of wound generally bleeds rapidly and heavily. If the cut is deep, muscles, tendons and nerves may be damaged.

Lacerations

A laceration is a jagged, irregular or blunt breaking or tearing of soft tissues, often resulting from mishandling tools and machinery and other accidents. Bleeding from a laceration may be rapid and extensive.

Punctures

A puncture is a piercing wound that causes a small hole in the tissues. Such objects as nails, needles, ice picks and other pointed objects can produce puncture wounds. Even if external bleeding is slight, there may be serious internal bleeding resulting from internal damage to an organ (as in a gunshot wound). All puncture wounds require the attention of a health professional because of the danger of tetanus.

Avulsions

An avulsion is a forcible tearing or partial tearing away of tissues. It occurs in such accidents as gunshot wounds, explosions, animal bites or other body-crushing injuries. Bleeding is heavy and rapid.

If a body part (a finger, tooth or toe, for example) has been torn away in an accident, it should always be sent along with the victim to the hospital (placed on moistened gauze and cooled), since there is a possibility that it can be reattached.

Treatment

First Aid

When a cut is located on a certain part of the body, such as the lips or eyelids, or a part of the body that bends and puts stress on the cut, a physician may need to place stitches or sutures to close the wound. In general, sutures are used to hold the two edges of a wound together so that healing can occur with a minimum of scarring. Also, they might be required if the wound is deep and tends to gape widely, or if the bleeding cannot be controlled after 20 minutes of direct pressure.

The physician will often inject some local anesthetic (numbing medicine) to the area around the wound so that suturing will be less painful. Generally, if a cut is less than one half an inch long, not deep, or the edges of the skin tend to fall together, then sutures may not be needed.

Some physicians may use a skin glue (DermaBond) to close small wounds, especially in children.

Puncture wounds that stop bleeding rapidly present special problems. Such wounds can become infected easily and may harbor tetanus bacteria (lockjaw).

Infection

After an injury that causes a break in the skin or after an operation, various wound infections may occur. The wound may be red, tender, painful or produce pus.

One type of infection is cellulitis (inflammation of the skin caused by bacteria). Another is gangrene, which can result in death or decay of tissues.

Necrotizing subcutaneous infection is a severe infection caused by bacteria that infect the tissue through wounds. The primary symptoms are swelling, discoloration and death of the surrounding tissue. The skin around the wound becomes hot, inflamed, tender and red. If the infection worsens, the skin may become discolored and gangrene may develop.

"Gas gangrene" results when a wound becomes infected by certain bacteria, usually Clostridium. This infection causes sudden pain and swelling around the wound, moderate increase in temperature, decrease in blood pressure and rapid heartbeat. Skin around the wound becomes pale, due to fluid that builds under it and a watery, foul-smelling, brownish-red fluid may be released. The tissue changes from pale to dusky to highly discolored as the infection worsens. Treatment consists of penicillin given intravenously. Surgical removal of infected tissue is essential, and removal of surrounding tissue is usually necessary.

As with any wound, it is important to have a physician inspect the wound and help decide if sutures, antibiotics, tetanus therapy or other treatment is necessary.

Questions

What should the wound be cleaned with and should the cleansing process be repeated?

Are sutures necessary?

Should an antibacterial ointment be applied on the wound?

Will you be prescribing any antibiotics? What are the side effects?

Do I need a tetanus shot?

Should the wound be covered or left open?

How long will the wound take to heal?

Are there any signs or symptoms that should be watched for and reported to the doctor?

Self-Care

Allow the wound to bleed freely and clean itself out, unless there has been a large loss of blood or the blood is squirting out, in which case you need to apply pressure to stop the bleeding.

Cleanse the wound with soap and water (or hydrogen peroxide) as throughly as possible. You should also try to remove all particles or debris to prevent infection or scarring before applying a sterile dressing. Minor cuts, however, often heal more quickly if left uncovered.